Release Of Liability Waiver

My role*

CLUB MEMBERCLUB GUESTVOLUNTEER

Guest participation date:*

Date

Guest Participants: This waiver will apply to future participation dates up to the maximum allowed by Arkansas Canoe Club NW Chapter. If guest becomes a full member this waiver will extend to apply to remainder of current year membership.

Your Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Date of Birth*

Date

Emergency Contact*

First NameLast Name

Emergency Contact Phone*

Area CodePhone Number

Are you under 18yrs old?*

NOYES

In consideration of being allowed to participate in any way in this sports activity, related events and activities, the undersigned appreciates and acknowledges:

1) I understand the risk of injury or illness from the activities involved in this sport is significant, including the potential for permanent paralysis and death; and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury or illness does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM ALL NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; and,

2) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately; and,

3) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS UNITED STATES DRAGON BOAT FEDERATION; ROSE CITY ROCKETS PADDLING CLUB; their officers & directors, officials, agents,and/or employees, other participants, sponsoring agencies, commissions, sponsors, advertisers, volunteers, coaches, steerers, and, if applicable, owners and lessors of premises and equipment used to conduct club activities hereby refered to as “RELEASEES”, WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

4) I also acknowledge that photographs and video may be taken of me in my participation in, and attendance at this event or club activity, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of club activities, special race, and/or in the promotion of such, its location, other sporting events, sport in general, and/or related purposes.

By signing below I acknowledge that I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY.

Signature*

Signed by*

First NameLast Name

A PARENT/LEGAL GUARDIAN MUST COMPLETE AND SIGN BELOW IF PARTICIPANT IS UNDER 18 YEARS OF AGE

This is to certify that I, as parent/legal guardian with legal responsibility for this PARTICIPANT, I have read the waiver of liability to the minor participant and confirm they fully understand its contents and therefore, I do consent and agree to his/her Waiver, Release and Indemnification, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement in the paddling program as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Minor Date of Birth*

Date

Name of Parent/ Guardian*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to Participant*

Signature of Parent Legal Guardian*

Date*

Date

CLUB LIABILITY WAIVER